14 results on '"Byrtek, M."'
Search Results
2. [18F] Positron emission tomography response after rituximab-containing induction therapy in follicular lymphoma is an independent predictor of survival after adjustment for FLIPI in academic and community-based practice.
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Wong-Sefidan I, Byrtek M, Zhou X, Friedberg JW, Flowers CR, Zelenetz AD, Dawson KL, and Reid E
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- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Female, Humans, Lymphoma, Follicular drug therapy, Lymphoma, Follicular pathology, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Staging, Prognosis, Rituximab administration & dosage, Survival Analysis, Tomography, X-Ray Computed, Treatment Outcome, Fluorodeoxyglucose F18, Lymphoma, Follicular diagnostic imaging, Lymphoma, Follicular mortality, Positron-Emission Tomography methods
- Abstract
Positron emission tomography (PET) after induction therapy in follicular lymphoma (FL) is predictive of survival in clinical trials. We describe use of PET and computed tomography (CT) after rituximab-based induction therapy in FL patients followed by the National LymphoCare Study and explore the association between imaging response assessment and survival. Among 1289 patients, imaging consisted of: PET ± CT (35%), CT alone (42%), other/no imaging (24%). Median follow-up was 7.6 years. In unadjusted analyses, positive PET ± CT and CT were prognostic of inferior OS (HR 1.78; 95% CI: 1.16-2.72 and HR 1.61, 95% CI: 1.13-2.29, respectively) and PFS (HR 1.63, 95% CI: 1.21-2.20 and HR 1.45, 95% CI: 1.12-1.89, respectively). Adjusting for FL International Prognostic Index, PET remained predictive of OS (HR 1.54, 95% CI: 1.01-2.36) and PFS (HR 1.54, 95% CI: 1.14-2.07). Residual disease via PET in FL is prognostic of survival in clinical practice.
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- 2017
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3. Randomized Open-Label Phase II Trial of Apitolisib (GDC-0980), a Novel Inhibitor of the PI3K/Mammalian Target of Rapamycin Pathway, Versus Everolimus in Patients With Metastatic Renal Cell Carcinoma.
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Powles T, Lackner MR, Oudard S, Escudier B, Ralph C, Brown JE, Hawkins RE, Castellano D, Rini BI, Staehler MD, Ravaud A, Lin W, O'Keeffe B, Wang Y, Lu S, Spoerke JM, Huw LY, Byrtek M, Zhu R, Ware JA, and Motzer RJ
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- Adult, Aged, Aged, 80 and over, Antineoplastic Agents pharmacokinetics, Antineoplastic Agents therapeutic use, Biomarkers, Tumor metabolism, Bridged Bicyclo Compounds, Heterocyclic pharmacokinetics, Carcinoma, Renal Cell blood supply, Carcinoma, Renal Cell enzymology, Carcinoma, Renal Cell metabolism, Disease-Free Survival, Female, Humans, Kidney Neoplasms blood supply, Kidney Neoplasms enzymology, Kidney Neoplasms metabolism, Male, Mechanistic Target of Rapamycin Complex 1, Middle Aged, Multiprotein Complexes antagonists & inhibitors, Phosphoinositide-3 Kinase Inhibitors, Pyrimidines pharmacokinetics, TOR Serine-Threonine Kinases antagonists & inhibitors, Bridged Bicyclo Compounds, Heterocyclic therapeutic use, Carcinoma, Renal Cell drug therapy, Everolimus therapeutic use, Kidney Neoplasms drug therapy, Pyrimidines therapeutic use
- Abstract
Purpose: To the best of our knowledge, this study is the first to compare dual inhibition of PI3K/mammalian target of rapamycin (mTOR) by apitolisib (GDC-0980) against single inhibition of mTORC1 by everolimus in metastatic renal cell carcinoma (mRCC)., Patients and Methods: Patients with clear-cell mRCC who progressed on or after vascular endothelial growth factor-targeted therapy were randomly assigned to apitolisib 40 mg once per day or to everolimus 10 mg once per day. End points included progression-free survival, safety, overall survival, and objective response rate. Biomarker assessments were conducted., Results: Eighty-five patients were randomly assigned. After 67 events, stratified analysis revealed that median progression-free survival was significantly shorter for apitolisib than for everolimus (3.7 v 6.1 months; hazard ratio, 2.12 [95% CI, 1.23 to 3.63; P < .01]); apitolisib was not favored in any stratification subgroup. Median overall survival was not significantly different but trended in favor of everolimus (16.5 v 22.8 months; hazard ratio, 1.77 [95% CI, 0.97 to 3.24; P = .06]). The objective response rate was 7.1% for apitolisib and 11.6% for everolimus. Patients administered apitolisib with a greater incidence of grade 3 to 4 adverse events were more likely to discontinue treatment (31% v 12% for everolimus). No drug-related deaths were observed. Apitolisib in comparison with everolimus was associated with substantially more high-grade hyperglycemia (40% v 9%) and rash (24% v 2%). Apitolisib pharmacokinetics suggested a relationship between exposure, and rash and hyperglycemia. Retrospective biomarker analyses revealed a relationship between VHL mutation status and outcome with everolimus but not with apitolisib. High hypoxia-inducible factor 1α protein expression was associated with better outcome in both arms., Conclusion: This study demonstrated that dual PI3K/mTOR inhibition by apitolisib was less effective than was everolimus in mRCC, likely because full blockade of PI3K/mTOR signaling resulted in multiple on-target adverse events. VHL mutation and hypoxia-inducible factor 1α expression may be predictive of an mTOR inhibitor benefit, although prospective validation is required., (© 2016 by American Society of Clinical Oncology.)
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- 2016
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4. Outcomes following watchful waiting for stage II-IV follicular lymphoma patients in the modern era.
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Nastoupil LJ, Sinha R, Byrtek M, Ziemiecki R, Zhou X, Taylor M, Friedberg JW, Link BK, Cerhan JR, Dawson K, and Flowers CR
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- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Female, Humans, Kaplan-Meier Estimate, Lymphoma, Follicular drug therapy, Lymphoma, Follicular pathology, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Rituximab administration & dosage, Rituximab therapeutic use, Treatment Outcome, Lymphoma, Follicular therapy, Watchful Waiting
- Abstract
To examine the effectiveness of an initial management strategy of watchful waiting for follicular lymphoma (FL) in clinical practice, we compared outcomes for patients diagnosed 2004-2007 in the United States initially managed with watchful waiting with outcomes following initial rituximab monotherapy and chemoimmunotherapy. In total, 1754 stage II-IV patients in the National LymphoCare Study underwent watchful waiting (n = 386), rituximab monotherapy (n = 296) or rituximab plus chemotherapy (n = 1072) as initial management strategy. Female patients and those who received treatment in the Northeast or in an academic setting more commonly underwent watchful waiting versus initial chemoimmunotherapy; whereas patients with grade 3 histology, anaemia, elevated lactate dehydrogenase, extranodal involvement, B symptoms or performance status ≥1 more commonly received chemoimmunotherapy. Although time to new treatment and progression-free survival following first- and second-line therapy were improved with chemoimmunotherapy, and time to chemotherapy was improved with rituximab monotherapy, there were no differences in overall survival between watchful waiting and chemoimmunotherapy or rituximab monotherapy. With 8-year overall survival estimates of 74%, initial management with watchful waiting in the context of sequential therapy remains a viable option for FL patients in the modern era. This trial was registered at www.clinicaltrials.gov (NCT00097565)., (© 2016 John Wiley & Sons Ltd.)
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- 2016
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5. Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS).
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Wagner-Johnston ND, Link BK, Byrtek M, Dawson KL, Hainsworth J, Flowers CR, Friedberg JW, and Bartlett NL
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- Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived administration & dosage, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Cell Transformation, Neoplastic pathology, Databases, Factual, Disease-Free Survival, Female, Humans, Lymphoma, Follicular mortality, Lymphoma, Large B-Cell, Diffuse mortality, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Rituximab, Stem Cell Transplantation, Time Factors, United States epidemiology, Lymphoma, Follicular pathology, Lymphoma, Follicular therapy, Lymphoma, Large B-Cell, Diffuse pathology, Lymphoma, Large B-Cell, Diffuse therapy
- Abstract
We assessed the incidence, prognostic features, and outcomes associated with transformation of follicular lymphoma (FL) among 2652 evaluable patients prospectively enrolled in the National LymphoCare Study. At a median follow-up of 6.8 years, 379/2652 (14.3%) patients transformed following the initial FL diagnosis, including 147 pathologically confirmed and 232 clinically suspected cases. Eastern Cancer Oncology Group performance status >1, extranodal sites >1, elevated lactate dehydrogenase, and B symptoms at diagnosis were associated with transformation risk. Relative to observation, patients initiating treatment at diagnosis had a reduced risk of transformation (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.46-0.75). The risk of transformation was similar in patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone compared with rituximab, cyclophosphamide, vincristine, and prednisone (adjusted HR, 0.94; 95% CI, 0.62-1.42). Maintenance rituximab was associated with reduced transformation risk (HR, 0.67; 95% CI, 0.46-0.97). Five-year survival from diagnosis was significantly worse for patients with vs without transformation (75%, 95% CI, 70-79 vs 85%, 95% CI, 83-86). The median overall survival post-transformation was 5 years. Forty-seven patients with evidence of transformation at the time of diagnosis shared similar prognostic factors and survival rates to those without transformation. Improved outcomes for transformation in the modern era are suggested by this observational study. This trial is registered at www.clinicaltrials.gov as #NCT00097565., (© 2015 by The American Society of Hematology.)
- Published
- 2015
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6. Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study.
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Casulo C, Byrtek M, Dawson KL, Zhou X, Farber CM, Flowers CR, Hainsworth JD, Maurer MJ, Cerhan JR, Link BK, Zelenetz AD, and Friedberg JW
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- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived administration & dosage, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Cyclophosphamide administration & dosage, Disease-Free Survival, Doxorubicin administration & dosage, Drug Administration Schedule, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Odds Ratio, Prednisone administration & dosage, Risk Assessment, Risk Factors, Rituximab, Time Factors, Treatment Outcome, United States epidemiology, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Follicular drug therapy, Lymphoma, Follicular mortality, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local mortality
- Abstract
Purpose: Twenty percent of patients with follicular lymphoma (FL) experience progression of disease (POD) within 2 years of initial chemoimmunotherapy. We analyzed data from the National LymphoCare Study to identify whether prognostic FL factors are associated with early POD and whether patients with early POD are at high risk for death., Patients and Methods: In total, 588 patients with stage 2 to 4 FL received first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Two groups were defined: patients with early POD 2 years or less after diagnosis and those without POD within 2 years, the reference group. An independent validation set, 147 patients with FL who received first-line R-CHOP, was analyzed for reproducibility., Results: Of 588 patients, 19% (n = 110) had early POD, 71% (n = 420) were in the reference group, 8% (n = 46) were lost to follow-up, and 2% (n = 12) died without POD less than 2 years after diagnosis. Five-year overall survival was lower in the early-POD group than in the reference group (50% v 90%). This trend was maintained after we adjusted for FL International Prognostic Index (hazard ratio, 6.44; 95% CI, 4.33 to 9.58). Results were similar for the validation set (FL International Prognostic Index-adjusted hazard ratio, 19.8)., Conclusion: In patients with FL who received first-line R-CHOP, POD within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated FL. This high-risk FL population warrants further study in directed prospective clinical trials., Competing Interests: Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article., (© 2015 by American Society of Clinical Oncology.)
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- 2015
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7. Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma-related mortality in elderly follicular lymphoma in the United States.
- Author
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Nabhan C, Byrtek M, Rai A, Dawson K, Zhou X, Link BK, Friedberg JW, Zelenetz AD, Maurer MJ, Cerhan JR, and Flowers CR
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Disease-Free Survival, Female, Humans, Lymphoma, Follicular mortality, Lymphoma, Follicular pathology, Male, Middle Aged, Prognosis, Prospective Studies, Treatment Outcome, United States epidemiology, Young Adult, Lymphoma, Follicular epidemiology, Lymphoma, Follicular therapy
- Abstract
Data from the National LymphoCare Study (a prospective, multicentre registry that enrolled follicular lymphoma (FL) patients from 2004 to 2007) were used to determine disease characteristics, treatment patterns, outcomes and prognosis for elderly FL (eFL) patients. Of 2650 FL patients, 209 (8%) were aged >80 years; these eFL patients more commonly had grade 3 disease, less frequently received chemoimmunotherapy and anthracyclines, and had lower response rates when compared to younger patients. With a median follow-up of 6.9 years, 5-year overall survival (OS) for eFL patients was 59%; 38% of deaths were lymphoma-related. No treatment produced superior OS among eFL patients. In multivariate Cox models, anaemia, B-symptoms and male sex predicted worse OS (P < 0.01); a prognostic index of these factors (0, 1 or ≥ 2 present) predicted OS [hazard ratio (95% CI): ≥ 2 vs. 0, 4.72 (2.38-9.33); 1 vs. 0, 2.63 (1.39-4.98)], with a higher concordance index (0.63) versus the Follicular Lymphoma International Prognostic Index (0.55). The index was validated in an independent cohort. In the largest prospective US-based eFL cohort, no optimal therapy was identified and nearly 40% of deaths were lymphoma-related, representing baseline outcomes in the modern era., Competing Interests: Conflict-of-interest disclosures: C.N discloses consulting/advisory board roles for Genentech, Janssen, Celgene, Astellas, and Gilead. M.B discloses employment and stock options with Genentech. J.R.C discloses consulting/advisory roles with Genentech. K.D discloses employment and stock options with Genentech. C.R.F discloses consulting/advisory roles with Algeta, OptumRx, Biogen Idec, Genentech BioOncology, Roche, Celgene and research funding from Abbott, Celgene, Millennium/Takeda, Spectrum, Gilead, and Janssen/Pharmacyclics. J.W.F has no relevant conflict of interests to disclose. B.K.L discloses honoraria from Genentech, consulting and advisory roles with Genentech, AbbVie, Gilead, and research funding from Genentech, Millennium, Pharmacyclics, and Janssen. M.J.M has no relevant conflict of interests to disclose. A.R has no relevant conflict of interests to disclose. A.D.Z discloses consulting /advisory roles with Genentech, Celegene, Gilead, Amgen, Hospira, Reddy Laboratories and research funding from Genentech/Roche, Gilead, and BMS. X.Z is employed by RTI-HS, which has a research contract with Genentech., (© 2015 John Wiley & Sons Ltd.)
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- 2015
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8. Comparison of the effectiveness of frontline chemoimmunotherapy regimens for follicular lymphoma used in the United States.
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Nastoupil LJ, Sinha R, Byrtek M, Ziemiecki R, Taylor M, Friedberg JW, Koff JL, Link BK, Cerhan JR, Dawson KL, and Flowers CR
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- Adult, Aged, Aged, 80 and over, Female, Humans, Kaplan-Meier Estimate, Lymphoma, Follicular mortality, Lymphoma, Follicular pathology, Male, Middle Aged, Neoplasm Grading, Neoplasm Metastasis, Neoplasm Staging, Treatment Outcome, United States, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Follicular drug therapy
- Abstract
To compare the effectiveness of frontline rituximab-chemotherapy regimens in clinical practice, we examined outcomes for patients with low-grade, stage III/IV follicular lymphoma receiving rituximab (R) with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), R with cyclophosphamide, vincristine and prednisone (R-CVP) or R with a fludarabine-based regimen (R-Flu) as frontline therapy. In total, 611 patients meeting these criteria were identified in the National LymphoCare Study: 47% receiving R-CHOP (n = 287), 31% receiving R-CVP (n = 187) and 22% receiving R-Flu (n = 137). Overall response rates were high (R-CVP 87%, R-CHOP 93%, R-Flu 94%; p = 0.017). Median follow-up was 7.4 years. R-CVP was associated with lower 5-year overall survival (R-CVP 76%, R-CHOP 86%, R-Flu 86%; p = 0.021) and progression-free survival (R-CVP 49%, R-CHOP 58%, R-Flu 64%; p = 0.029). There were no significant differences in survival in Cox models adjusted for baseline clinical factors, practice region/setting and post-treatment R maintenance/observation.
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- 2015
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9. The use and effectiveness of rituximab maintenance in patients with follicular lymphoma diagnosed between 2004 and 2007 in the United States.
- Author
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Nastoupil LJ, Sinha R, Byrtek M, Zhou X, Taylor MD, Friedberg JW, Link BK, Cerhan JR, Dawson K, and Flowers CR
- Subjects
- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived adverse effects, Antineoplastic Combined Chemotherapy Protocols adverse effects, Disease-Free Survival, Female, Humans, Induction Chemotherapy, Lymphoma, Follicular epidemiology, Lymphoma, Follicular pathology, Lymphoma, Follicular therapy, Maintenance Chemotherapy, Male, Middle Aged, Prospective Studies, Randomized Controlled Trials as Topic, Rituximab, Survival Analysis, Treatment Outcome, United States epidemiology, Young Adult, Antibodies, Monoclonal, Murine-Derived therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymphoma, Follicular drug therapy
- Abstract
Background: The authors examined the "real-world" effectiveness of rituximab (R) maintenance therapy (R-maintenance) compared with observation after R-based induction therapy in patients with previously untreated follicular lymphoma (FL) in the United States., Methods: The National LymphoCare Study is a prospective, multicenter, observational study that enrolled > 2700 untreated patients with FL diagnosed from 2004 to 2007 at 265 sites in the United States. Among these, patients who achieved at least stable disease after R-based induction therapy were eligible for the current analysis. Patients who initiated R-maintenance within 215 days of completing induction therapy were categorized as the R-maintenance group, and those who did not initiate therapy during this period were categorized as the observation group. The objective of the current study was to determine the effect of R-maintenance on progression-free survival (PFS), time to next treatment (TTNT), and overall survival (OS)., Results: A total of 1439 patients completed R-based induction therapy, 1186 of whom met all inclusion criteria (541 patients received R-maintenance and 645 patients were observed). Characteristics that were found to be predictive of receiving R-maintenance were histology grade (1/2), Ann Arbor stage of disease (III/IV), geographic region (region other than the West), and practice setting (community practice). With a median follow-up of 5.7 years, R-maintenance was associated with superior PFS (hazards ratio [HR], 0.68; 95% confidence interval [95% CI], 0.56-0.84 [P = .0003]) and TTNT (HR, 0.66; 95% CI, 0.52-0.84 [P = .0007]). No significant difference in OS was observed (HR, 0.81; 95% CI, 0.58-1.14 [P = .23])., Conclusions: R-maintenance in patients with FL and at least stable disease after R-based induction therapy provided significantly longer PFS and TTNT in comparison with observation, but no significant difference in OS was observed with 5-years of follow-up. This comparative effectiveness study aligns with the results of randomized trials suggesting that similar outcomes occur with R-maintenance in FL with the treatment variations observed in clinical practice., (© 2014 The Authors.Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.)
- Published
- 2014
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10. Patterns of delivery of chemoimmunotherapy to patients with follicular lymphoma in the United States: results of the National LymphoCare Study.
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Martin P, Byrtek M, Dawson K, Ziemiecki R, Friedberg JW, Cerhan JR, Flowers CR, and Link BK
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- Aged, Antibodies, Monoclonal, Murine-Derived therapeutic use, Antineoplastic Agents, Alkylating administration & dosage, Antineoplastic Agents, Hormonal administration & dosage, Antineoplastic Agents, Phytogenic administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Cyclophosphamide administration & dosage, Cyclophosphamide therapeutic use, Doxorubicin therapeutic use, Female, Humans, Male, Middle Aged, Observational Studies as Topic, Prednisone administration & dosage, Prednisone therapeutic use, Prospective Studies, Rituximab, Treatment Outcome, United States, Vidarabine administration & dosage, Vidarabine analogs & derivatives, Vincristine administration & dosage, Vincristine therapeutic use, Antibodies, Monoclonal, Murine-Derived administration & dosage, Antineoplastic Agents administration & dosage, Lymphoma, Follicular therapy
- Abstract
Background: Drug choice and delivered dose of treatment potentially influence outcome in patients treated for follicular lymphoma (FL). Historically, observational studies have evaluated drug choice. The National LymphoCare Study (NLCS) is a prospective, observational study of patients with FL who were enrolled at academic and community practice sites in the United States between 2004 and 2007. In the current study, the authors report on measures of delivered dose and its impact on outcomes for the most common first-line regimens., Methods: All evaluable patients with FL who were treated with initial rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP); or rituximab plus a fludarabine-containing regimen (R-Flu) were included. Associations between baseline factors, choice of treatment, number of cycles received, completion of therapy, and patient outcomes were assessed., Results: A total of 646 patients received R-CHOP, 297 received R-CVP, and 222 received R-Flu. Characteristics were similar between the 3 groups with the following exceptions. Patients receiving R-CHOP were more often found to have grade 3 FL and patients receiving R-CVP were older and had higher Follicular Lymphoma International Prognostic Index scores. The majority of patients (80%) received ≥ 5 cycles of treatment. Toxicity, but not disease progression, was commonly cited as the reason for the early discontinuation of treatment (51% vs 6%). Time to retreatment was shorter for patients receiving ≤ 4 cycles, regardless of the treatment regimen used. The number of cycles was associated with overall survival, progression-free survival, and lymphoma-related mortality for patients receiving R-CVP., Conclusions: The majority of patients with FL receiving chemoimmunotherapy in the NLCS completed ≥ 5 cycles of treatment. Strategies to improve dose delivery appear unlikely to impact outcomes, except possibly in patients receiving R-CVP. Although early treatment discontinuation appears to be associated with survival, this analysis does not implicate causality., (© 2013 American Cancer Society.)
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- 2013
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11. Examination of the follicular lymphoma international prognostic index (FLIPI) in the National LymphoCare study (NLCS): a prospective US patient cohort treated predominantly in community practices.
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Nooka AK, Nabhan C, Zhou X, Taylor MD, Byrtek M, Miller TP, Friedberg JW, Zelenetz AD, Link BK, Cerhan JR, Dillon H, Sinha R, Shenoy PJ, Levy D, Dawson K, Hirata JH, and Flowers CR
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- Aged, Antibodies, Monoclonal, Murine-Derived therapeutic use, Cohort Studies, Community Health Centers, Disease-Free Survival, Female, Humans, Lymphoma, Follicular classification, Male, Middle Aged, Neoplasm Grading, Prospective Studies, Risk Factors, Rituximab, Treatment Outcome, Watchful Waiting, Lymphoma, Follicular drug therapy, Lymphoma, Follicular mortality
- Abstract
Background: Because follicular lymphoma (FL) patients have heterogeneous outcomes, the FL international prognostic index (FLIPI) was developed to risk-stratify patients and to predict survival. However, limited data exist regarding the role of FLIPI in the era of routine first-line rituximab (R) and R-chemotherapy regimens and in the setting of community oncology practices., Patients and Methods: We evaluated the outcome data from the National LymphoCare Study (NLCS), a prospective, observational cohort study, which collects data on patients with FL in the United States (US) community practices., Results: Among 1068 male and 1124 female patients with FLIPI data, most were treated in US community practices (79%); 35% were FLIPI good risk, 30% intermediate risk, and 35% poor risk. FLIPI risk groups were significant predictors of overall survival (OS) and progression-free survival (PFS) for patients who undergo watchful waiting (WW), and those who receive non-R-containing regimens, R-alone, and R-chemotherapy combinations., Conclusions: In the setting of contemporary practice with routine R use, stratifying patients into good, intermediate, and poor FLIPI risk groups predicts distinct outcomes in terms of OS and PFS. FLIPI remains an important prognostic index in the R era and should be used in clinical practices to support discussions about prognosis.
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- 2013
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12. Racial differences in presentation and management of follicular non-Hodgkin lymphoma in the United States: report from the National LymphoCare Study.
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Nabhan C, Byrtek M, Taylor MD, Friedberg JW, Cerhan JR, Hainsworth JD, Miller TP, Hirata J, Link BK, and Flowers CR
- Subjects
- Adult, Aged, Anthracyclines, Antibodies, Monoclonal, Murine-Derived, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Lymphoma, Follicular epidemiology, Lymphoma, Follicular pathology, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Prospective Studies, Rituximab, United States epidemiology, Black or African American statistics & numerical data, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Healthcare Disparities statistics & numerical data, Hispanic or Latino statistics & numerical data, Lymphoma, Follicular diagnosis, Lymphoma, Follicular therapy, White People statistics & numerical data
- Abstract
Background: Racial differences in follicular lymphoma (FL) in the United States have not been investigated., Methods: The National LymphoCare Study is a multicenter, longitudinal, observational cohort study collecting data on treatment patterns and outcomes for patients with newly diagnosed FL in the United States between 2004 and 2007 without any predefined, study-specific intervention. The authors investigated differences between white (W) patients, African American (AA) patients, and Hispanic (H) patients., Results: Among 2744 enrolled patients, there were 95 (3%) AA patients, 125 (5%) H patients, and 2476 (90%) W patients. Compared with W patients, more AA and H patients were diagnosed at age <45 years (P < .0001). H patients more commonly were diagnosed with grade 3 FL compared with AA and W patients (29%, 13%, and 18%, respectively; P = .019) and more commonly received rituximab plus chemotherapy as initial therapy compared with W patients (66% vs 50%; P = .036), while AA patients less commonly received anthracyclines (49% vs 64% in W patients; P = .027). H and AA patients who received rituximab plus chemotherapy were less likely than W patients to receive maintenance rituximab (27% vs 31% vs 40%, respectively; P = .031). At a median follow-up of 52 months, progression-free survival was similar between AA and W patients but was longer in H patients, and there was no difference in overall survival., Conclusions: In the largest prospective cohort to date of AA and H patients with FL in the United States, AA and H patients were younger at presentation. Although racial differences in treatment patterns for FL were noted, additional follow-up is needed to determine the impact of these differences on survival., (Copyright © 2012 American Cancer Society.)
- Published
- 2012
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13. Effectiveness of first-line management strategies for stage I follicular lymphoma: analysis of the National LymphoCare Study.
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Friedberg JW, Byrtek M, Link BK, Flowers C, Taylor M, Hainsworth J, Cerhan JR, Zelenetz AD, Hirata J, and Miller TP
- Subjects
- Antibodies, Monoclonal, Murine-Derived therapeutic use, Antineoplastic Agents therapeutic use, Combined Modality Therapy, Follow-Up Studies, Guideline Adherence, Humans, Lymphoma, Follicular pathology, Lymphoma, Follicular radiotherapy, Middle Aged, Neoplasm Staging, Practice Guidelines as Topic, Registries statistics & numerical data, Rituximab, Survival Analysis, Treatment Outcome, United States, Lymphoma, Follicular therapy
- Abstract
Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT)., Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database., Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival., Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.
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- 2012
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14. Fluoridation and tooth wear in Irish adults.
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Burke FM, Whelton H, Harding M, Crowley E, O'Mullane D, Cronin M, Kelleher V, and Byrtek M
- Subjects
- Adolescent, Adult, Age Factors, Aged, Female, Health Surveys, Humans, Ireland epidemiology, Male, Middle Aged, Oral Health, Sex Factors, Young Adult, Fluoridation, Tooth Wear epidemiology
- Abstract
The aim of this study was to determine the prevalence of tooth wear in adults in Ireland and its relationship with water fluoridation. The National Survey of Adult Oral Health was conducted in 2000/2001. Tooth wear was determined using a partial mouth examination assessing the upper and lower anterior teeth. A total of 2456 subjects were examined. In this survey, increasing levels and severity of tooth wear were associated with ageing. Men were more affected by tooth wear and were more likely to be affected by severe tooth wear than women. It was found that age, and gender were significant predictors of tooth wear (P < 0.01). Overall, there was no significant relationship between fluoridation and tooth wear in this study., (© 2010 John Wiley & Sons A/S.)
- Published
- 2010
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